ENA Connection March 2014 by ENA Connection

the Official Magazine of the Emergency Nurses Association

connection

March 2014 Volume 38, Issue 3

FORCES at work

Even in a Battle Zone, Heart and Humanity Are Most Central to Our Mission PAGE 6

PLUS . . . Lantern Award Taken Literally TNCC, ENPC on Top of the World

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SEVENTH EDITION

TNCC, widely recognized as the premier course for hospitals and trauma centers worldwide, empowers nurses with the knowledge, critical thinking skills, and hands-on training to provide expert care for trauma patients. § Rapid identification of life-threatening injury and disease § Comprehensive patient assessment § Enhanced intervention for better patient outcomes

2 Day Intensive Course § 24 Chapter Comprehensive Manual § 6 Hands-on Skill Stations 5 Online Modules § Special Population Chapters

Available Now

Visit www.ena.org/TNCC to find a course near you. The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Dates to Remember March 1, 2014 Deadline for resolution proposals for the 2014 ENA Annual Conference in Indianapolis March 5-9, 2014 Leadership Conference, Phoenix March 31, 2014 Deadline for nominations for ENA annual awards May 6-7, 2014 Day on the Hill, Washington, D.C.

ENA Exclusives PAGE 6 Risk Meets Reward: Making a Difference in a Combat Zone PAGE 8 Lighting the Way: Physicians Group Gives Colorado ED a Literal Lantern PAGE 14 A Common Syndrome Presenting With a Dramatic Event PAGE 17 Hazmat Incident Resource Upgraded PAGE 18 ENA Corkboard: What Makes a Great Emergency Nursing Leader? PAGE 20 Cold Fusion: TNCC, ENPC Reach the Top of the World in Nunavut PAGE 24 Code You: 6 Ways to Maintain a Positive Mental Attitude

Regular Features PAGE 4 Free CE of the Month Letters to the Editor PAGE 10 ENA Foundation PAGE 12 CourseBytes PAGE 19 ENA Connected PAGE 23 Board Writes PAGE 26 Ask ENA

FROM THE PRESIDENT | Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN

‘Are You the Patient in Bed 12?’ E

xcellent communication skills are essential in an emergency department. We are under pressure to assess our patients, complete orders and interventions and work to move our patients toward a timely disposition decision. To do that safely and efficiently, we need to make sure we are communicating effectively with the entire ED team. We know that two-thirds of all sentinel events are caused by communication failures. In the ED, when we are busy, stressed and trying to multitask, we resort to communication shortcuts that ultimately can have disastrous consequences. ‘‘Hey, John, can you please take the patient in Bed 1 to CT scan?’’ ‘‘Judy, do you mind throwing a line in and drawing labs on the guy in Bed 12?’’ ‘‘Anyone know where the patient in Bed 5 went?’’ Does any of this sound familiar to you? Many of us commonly refer to room numbers rather than distinct patient identifiers when giving or receiving direction in our departments. Now imagine if the patient needing the CT scan was in Bed 2, not Bed 1. And the patient in Bed 1 not only received an unnecessary dose of radiation but received IV contrast, had an anaphylactic reaction and ended up in the intensive care unit in multisystem organ failure — devastating consequences from an innocent attempt at getting a patient where he or she needs to be. While we might be religious about checking two patient identifiers when administering a medication (and we should be) those identifiers are

equally as important every time we are interacting with a patient. Another common situation in which we tend to let our communication skills slack off a bit is during a critical patient situation. In the best of situations, these events tend to feel like organized chaos. To facilitate

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Official Magazine of the Emergency Nurses Association

Stay current in treating patients who have had bariatric surgery with this month’s free continuing education offering from ENA!

Available to you starting March 1 . . . ‘‘Bariatric Surgery: Evidence-Based Updates,’’ presented by Ruth E. Rea, PhD, RN. (Credit: 1.0 contact hour.) Rea outlines the types, benefits and complications of bariatric surgery, then explains how to modify assessments and interventions associated with specific problems of patients who have had bariatric surgery. The course includes a case study of a patient who had bariatric surgery with a life-threatening emergency. Recorded at the 2013 Annual Conference in Nashville, Tenn. To take this and other eLearning courses free as an ENA member: •G o to www.ena.org/freeCE, where you’ll log in as a member (or create an account). • Add desired courses to your cart and ‘‘check out.’’ • Proceed to your Personal Learning Page to start or complete any course for which you have registered or to print a final certificate. • To return to your Personal Learning Page later, go to www.ena.org and find ‘‘Go to Personal Learning Page’’ under the Education tab. Please be sure you are using the e-mail address associated with your membership when logging in. If you have questions about any free eLearning course or the checkout process, e-mail elearning@ena.org.

ENA Connection is published 11 times per year from January to December by: The Emergency Nurses Association 915 Lee Street Des Plaines, IL 60016-6569 and is distributed to members of the association as a direct benefit of membership. Copyright ©2014 by the Emergency Nurses Association. Printed in the U.S.A. Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.

POSTMASTER: Send address changes to ENA Connection 915 Lee Street Des Plaines, IL 60016-6569 ISSN: 1534-2565 Fax: 847-460-4002 Website: www.ena.org E-mail: connection@ena.org

Member Services: 800-900-9659 Non-member subscriptions are available for $50 (USA) and $60 (foreign).

ENA Connection welcomes letters from members. Letters should address content previously published in the magazine. Letters may be edited for space and clarity. Submission does not guarantee publication. Please include your name, credentials and contact information for verification. Send letters to connection@ena.org.

just got home and pulled my ENA Connection out of the mail. Browsing through it, I found “Guided Tours” [January 2014, page 5] and started reading it immediately. I have visited the Vietnam Women’s Memorial in D.C. because it held a special connection for me. My aunt, Lt. Col. Shirley A. Strachan, USAF, was one of the women honored by that memorial. She, too, was an RN and served during the Vietnam War. She was stationed

in Okinawa and Tokyo, among other places. I did not realize it when I decided to go into nursing, but after transitioning to the ER, I understood that she had influenced me a great deal in that decision. My aunt died of cancer at age 68; I still miss her. Thank you for a moving story about a few of the women who served during that controversial war, and the steps we are taking to honor them today. Penny Blake, RN, CCRN, CEN

Do you have a recent professional or educational success story you want to share about yourself or an ENA member colleague? Have you won an award or earned a promotion? Has another member you know been recognized for outstanding work? Tell us! Send an e-mail to connection@ena.org with the subject line “Members in Motion.” Be sure to include names, credentials and, if applicable, photos of the nurse(s) being recognized. ENA staff may follow up with you for additional details.

Publisher: Kathy Szumanski, MSN, RN, NE-BC Editor-in-Chief: Amy Carpenter Aquino Associate Editor: Josh Gaby Senior Writer: Kendra Y. Mims Editorial Assistant: Renée Herrmann BOARD OF DIRECTORS Officers: President: Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN President-elect: Matthew F. Powers, MS, BSN, RN, MICP, CEN

Secretary/Treasurer: Kathleen E. Carlson, MSN, RN, CEN, FAEN Immediate Past President: JoAnn Lazarus, MSN, RN, CEN Directors: Ellen (Ellie) H. Encapera, RN, CEN Mitch Jewett, AA, RN, CEN, CPEN Michael D. Moon, PhD, MSN, RN, CNS-CC, CEN, FAEN Sally K. Snow, BSN, RN, CPEN, FAEN Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN Joan Somes, PhD, MSN, RN-BC, CEN, CPEN, FAEN, NREMT-P Karen K. Wiley, MSN, RN, CEN Executive Director: Susan M. Hohenhaus, LPD, RN, CEN, FAEN

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Potential complications may include local or systemic infection, hematoma, extravasations or other complications associated with percutaneous insertion of sterile devices. References: 1. Rogers JJ, Fox M, Miller LJ, Philbeck TE. Safety of intraosseous vascular access in the 21st century [WoCoVA abstract O-079]. J Vasc Access. 2012;13(2): 1A-40A. 2. Paxton JH, Knuth TE, Klausner HA. Proximal humerus intraosseous infusion: a preferred emergency venous access. J Trauma. 2009;67(3):1-7. 3. Cooper BR, Mahoney PF, Hodgetts TJ, Mellor A. Intra-osseous access (Ez-IO ® ) for resuscitation: UK military combat experience. J R Army Med Corps. 2007; 153(4):314-316. 4. Dolister M, Miller S, Borron S, et al. Intraosseous vascular access is safe, effective and costs less than central venous catheters for patients in the hospital setting [published online ahead of print January 3, 2013]. J Vasc Access. doi:10.5301/jva.5000130. *Research sponsored by the Vidacare Corporation. Teleflex and EZ-IO are trademarks or registered trademarks of Teleflex Incorporated or its affiliates. © 2014 Teleflex Incorporated. 2014-2673

MILITARY NURSING

risk meets

reward Dangers of Nursing in a Combat Zone Offset By the Chance to Make a Difference By Kendra Y. Mims, ENA Connection The viewpoints expressed in this story are those of the individual and do not necessarily reflect the positions of the U.S. Armed Forces.

‘I

ncoming, incoming, incoming!” Lt. Col. Gwyn Parris-Atwell heard the alarm right before the sound of an explosion. Her natural instincts as a military and emergency nurse were to respond, but ParrisAtwell, MSN, RN, CEN, FAEN, was in a hospital bed, her blood pressure in the low 50s, leaving her physically unable to help. It was her first night in ICU after becoming severely ill with food poisoning, and she was in contact isolation. She knew a situation had occurred but was unaware of the details. When both her ICU nurse and one of her senior nurses walked into her room dressed in their full combat gear, which included a helmet and individual body armor (IBA), she learned that an indirect fire attack (IDF) had occurred close to the Craig Joint Theatre Hospital Bagram Airfield, Afghanistan, killing four U.S. soldiers. Unable to walk and without her combat gear, Parris-Atwell had never felt so vulnerable in her life. She was informed there were some very serious injuries in the emergency department. ‘‘It’s odd being on the other side of

terror,’’ she said. ‘‘While lying in the hospital bed, I felt like I needed to have my combat gear on. I laid there and felt guilty and helpless that I could not get up and help in this particular situation because that’s what I do. I would have responded.’’ Parris-Atwell deployed to Bagram Airfield, the largest U.S. military base in Afghanistan, in May 2013 with the 455th Expeditionary Medical Group as the Flight Commander in the Contingency Aeromedical Staging Facility. She became ill 30 days after her arrival. Despite the IDF attack and being in ICU for several nights, her biggest fear was being sent home. ‘‘Most people may ask or volunteer to go home, but I’m thankful they didn’t send me home,’’ she said. ‘‘I wasn’t ready to go. I hadn’t done my job yet, and I didn’t want to leave my medics. I had 30 medics who worked for me, and I had the best of the best. I wanted to make sure that the people who worked with me were taken care of.’’ She believes the combat zone has changed. There is no longer a defined perimeter for a battlefield, she said. ‘‘There used to be a thought that medical assets were not in the combat zone, but the combat zone is so fluid today that you are at risk wherever you are serving,’’ she said. ‘‘Hospitals, wherever they are located, are at risk

“The human factor is not only in the civilian world, but it’s also in the military world.’’ Lt. Col. Gwyn Parris-Atwell, MSN, RN, CEN, FAEN (right, pictured in Afghanistan)

for an IDF attack or arms fire attack. I just don’t think it is safe anywhere anymore.’’ Despite increased dangers in the combat zone, Parris-Atwell usually felt well-protected because of her battle gear — roughly an extra 75 pounds. ‘‘The advances in our battle gear today make me feel more secure,’’ she said. ‘‘Our torso, head and the major vascular areas of our bodies are protected. I think the advances in our special protective equipment have certainly saved a lot of lives on our part and on our troops’ part. Eye protection alone can make a difference in someone’s injury.’’ She also has seen protective gear such as the newer Advanced Combat Helmet save a soldier from severe head trauma in Afghanistan. Parris-Atwell credits leadership for taking an active role in increasing the team’s protection by having a specific procedure in place when it came time to wear full battle gear and take care of patients during an IDF. ‘‘Every time we had an indirect fire attack, there was a full procedure we would follow,’’ she said. ‘‘We would immediately take cover, put on our helmets and IBAs and go directly to the hospital to report for duty and prepare for incoming wounded. That was so important to me because that’s

March 2014

Photo cropped to emphasize subject.

what we were there for. We were always ready.’’ Parris-Atwell has been an emergency nurse since 1983. She always had a passion for disaster nursing and triage, and it was the mentoring of nurses in the Army Nurse Corps that motivated her to join the army. One of the nurses who inspired her was ENA past president Lt. Col. Peggy McMahon, MN, RN, CEN, whom Parris-Atwell describes as her hero. Parris-Atwell was commissioned in the Army Nurse Corps in 1991 as a reservist and served 10 years before switching over to the Air Force Nurse Corps in 2000 as a captain. Afghanistan was Parris-Atwell’s third deployment after being sent to Iraq in 2010 and Germany in 2012. Though she has witnessed graphic and severe injuries while working in a combat zone, including wounds from improvised explosive devices, and she carries a weapon in the military, Parris-Atwell says it’s still very similar to providing emergency care in the civilian world. ‘‘I think the best military nurses are

emergency nurses because we are the best at emergency preparedness — we have to quickly react to things,’’ she said. ‘‘I feel you’re just as vulnerable in the ED as we are in the battlefield and combat zone on a daily basis. I think it can be a little more graphic in the combat zone, but I think it’s very graphic in the civilian world, especially Level 1 trauma centers or basic community EDs that get Level 1 trauma.’’ Family presence is different when taking care of patients in civilian emergency departments. ‘‘In the civilian ED, you can go out into the waiting room to get the family, but in a combat zone there is no family there, so you are their family until you can get them back to their loved ones,’’ she said. ‘‘I always think about who’s home waiting for them — is it a child, spouse, parents?’’ She recalls caring for severely wounded patients who were not going to live and others who had minor injuries during her deployment in Germany. The patients’ families were brought in to be with them or to fly

Official Magazine of the Emergency Nurses Association

back home with them on the aircraft. ‘‘It was very rewarding to also be able to take care of the family when I was stationed in Germany,’’ she said. ‘‘It’s something you normally don’t do in the combat zone. The human factor is not only in the civilian world, but it’s also in the military world.’’ Parris-Atwell also felt the camaraderie during her last deployment in Afghanistan while serving with NATO forces. She cared for Spanish and British troops, the Afghanistan National Army and civilians, including prisoners. She shared advice from her hospital commander: It doesn’t matter what you’re doing, who you’re taking care of or what their diagnosis is. They may have a simple sprained knee, a severe head injury or amputations. No matter what it is, take them by the hand and give them excellent care. She treated several troops from different countries. Though some of their injuries were not severe, a Spanish medic told her his troops had

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LIGHTING THE WAY

Physicians Group Gives Colorado ED a Literal Lantern to Celebrate Award-Winning Care By Amy Carpenter Aquino, ENA Connection

atients entering the emergency department at St. Anthony Hospital in Lakewood, Colo., likely don’t realize that the elegant iron lantern adorning the entrance is no mere decoration. Unless they have time to read the accompanying plaque, they won’t know this lantern is a symbol of the excellence achieved by the ED staff. Dr. Winston Tripp, SAH ED medical director, was inspired by the staff’s achievement to install the lantern and plaque, gifted by the Apex Emergency Physicians & Allied Health Professionals. The plaque reads, ‘‘You are entering a Lantern Award Emergency Department. The Lantern Award is a recognition award given to emergency departments that exemplify exceptional practice and innovative performance in the core areas of leadership, education, advocacy and research. This lantern is dedicated in honor of the exceptional staff of the St. Anthony Hospital Emergency Department and is light to all who seek our services.’’ Once they enter the hospital doors, patients experience for themselves the commitment to quality, safety, a healthy work environment and innovation in nursing practice and emergency care that distinguishes each Lantern Award ED. ‘‘It was so extremely touching and very supportive of our doctor group,’’ said Elizabeth Dunn, BSN, RN, CEN, administrative director of the St. Anthony ED. ‘‘They are so proud of us, but we could not have done it without them — we are a team.’’ The St. Anthony ED was one of nine national recipients of the 2013 ENA Lantern Awards and was recognized at the Awards Gala in Nashville, Tenn., in September. For Dunn and her staff, the journey to Lantern began two years earlier. Dunn was ED manager in 2011, the year the Lantern Awards were first given and the year that St. Anthony Hospital moved to a new facility six miles from its previous, 119-year-old home. She heard about the Lantern Award and began thinking that with all its strides toward improving patient satisfaction scores and the overall patient experience, the St. Anthony Hospital ED had a good chance of meeting the award criteria. She discussed the prospect with Sally Cowan, the ED director at the time, as well as Dr. Chris Ott, the 2011 ED medical director, who agreed that the staff was on the right track for clinical and professional excellence. ‘‘The staff had really started to shift their culture and attitude toward a patient-centered process before the 2011

Pictured at the Lantern dedication ceremony Dec. 17 are Dr. Christopher Ott (left), St. Anthony Hospital chief medical officer and former ED medical director; Elizabeth Dunn, BSN, RN, CEN, administrative director of the ED; and Dr. Winston Tripp, ED medical director and chief medical officer for the Apex Emergency Group.

move, and as we got to the new campus, that momentum of culture change continued to evolve,’’ she said. ‘‘At the same time, there was quite a bit of staff-driven engagement for evidence-based changes occurring, such as a unit-based council, and it seemed like the right time to pursue the Lantern application. It felt like we had transcended to the point of excellence with our patient experiences in addition to their clinical outcomes.’’ The staff continued building its professionalism and positivity within both the nursing and medical staff throughout 2012. Being in a new facility, it focused on engaging with patients and their families to the point that ‘‘it became the drive for the staff to excel with their experiences

March 2014

and their outcomes,’’ Dunn said. Where the ED staff had always been confident in patient outcomes, it now shifted its focus to realizing the full patient experience, as well as fully engaging with the community and pre-hospital agencies. ‘‘We know we provide optimal patient care, but the full realization of understanding how much we impact patient experiences, especially by treating them and their family members as a whole person, began to come full circle for the nursing and medical staff,’’ Dunn said. ‘‘We also started working on a variety of things besides the patient experiences, with our internal surge plan, discharge callbacks and ED safety initiative committee.’’ By mid-2012, the staff felt ready to tackle the 21-page Lantern Award application. ‘‘It was quite a bit of fun,’’ Dunn said. ‘‘I enjoyed it a lot because I could see the excellence in the staff. I think

sometimes what happens with care providers is that they are so used to doing what they do that they don’t see how incredible it is.’’ Filling out the application and laying out all the statistics allowed for introspection on how far the staff had come in the last few years. Some of the application questions were assigned to staff nurses with different experience levels and who worked different shifts. A question in the current application requires a staff nurse to provide an exemplar from the last two years that highlights factors that contribute to each of the following: 1. Your professional satisfaction, growth and development 2. Your willingness to stay in your emergency department 3. The impact you feel you make on safe patient care ‘‘Speaking specifically to the exemplar questions, it really transforms

a nurse to reflect within and say, wow, we are actually applying ourselves to exemplary care here,’’ Dunn said. ‘‘By their participation in the application, it empowered them — it gave them confidence to see that the things they did were of very high performance.’’ Dunn shared advice for departments considering applying for a Lantern Award: ‘‘Quite often, clinicians embody a fair amount of excellence that they don’t realize, typically because they think that this is the expected norm,’’ she said. What the Lantern Award offers is the chance to ‘‘really stop, take a breather and look at what you’re doing. Start writing about it and take the credit for your efforts regarding process improvement, recognition and professionalism. I think people will discover there is more evidence of excellence within their practice than they give themselves credit for.’’

Presents:

What it means to be a leader

Career Center

§ Integrity § Communication § Creativity

§ Passion § Confidence § Sense of Humor

Please join us for a panel discussion on the traits and qualities of successful nurse leaders. Followed by small group networking with the panelists.

Who: Emerging Leaders When: March 8, 2014, 6 pm Where: 2014 Leadership Conference, Phoenix, AZ

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Official Magazine of the Emergency Nurses Association

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ENA FOUNDATION | Seleem Choudhury, MSN, MBA, RN, CEN, 2014 ENA Foundation Chairperson

Building Broader Shoulders E

arly in my career, I fell in love with a Jewish proverb quoted by a mentor: ‘‘I ask not for a lighter burden but for broader shoulders.’’ It reminded me of our aspiration and calling as nurses to engage in lifelong learning. Nursing is not and never will be a destination — it is a journey to ensure first-rate patient care through developing our skills, growing our practice and attaining education. Nurses need broad shoulders to accomplish each of these goals. Part of the burden is the cost of obtaining an education, which is one of the most important investments you can make in yourself or in others. The ENA Foundation is here to help emergency nurses make this investment. Every year, the foundation raises record-breakings sums so that each of you can pursue the opportunity to increase your knowledge, realize your dreams and ultimately contribute toward first-rate emergency care. Your ENA Foundation is helping you build a strong career foundation. The ENA Foundation holds the annual State Fundraising Challenge to fund scholarships all across the United States. The math is quite simple: The more money we raise, the more educational scholarships we can dispense. We have generous donors and members who participate and donate every year; however, I often feel we are only scratching the surface. I believe there are some who do not donate or who are simply unaware of the role of the ENA Foundation. The State Fundraising Challenge typically has been the backbone of funding for your ENA Foundation. However, if you compare the amount raised to the number of ENA members, it is clear we can raise much more money. This year’s theme is ‘‘Building a Strong Foundation,’’ and the best way to build any structure is to start with what underpins the foundation. I believe our strength lies in the individual ENA member. You are what holds this professional organization together. We could not

exist without you. The ENA Foundation belongs to you. Its future is entwined with your future and the future of emergency nursing. As an ENA member, you can apply for a scholarship and are not bound by geography, education or money. It requires a simple application, which is reviewed and scored. Awards are given on merit, not on previous donations from either individuals or states. High-scored applications are awarded scholarships. If we can increase the number of donors, then we would increase the amount of money we can award. This ripple effect would truly help us build a stronger foundation. A rewarding part of my ENA Foundation role has been talking to scholarship recipients and hearing about how a scholarship changed their lives and sustained their passion for emergency nursing. Last year I was fortunate enough to call three doctoral scholarship recipients and hear firsthand as they exhaled with gratitude and excitedly told me how they were going to pay it forward to patients, fellow nurses, clinicians and the ENA Foundation. Frequently we hear of how recipients have paid back this investment by advancing care through research or changing the care we provide at the stretcherside. This is my fuel for working with the ENA Foundation. A specific question asked of all applicants is, ‘‘What will you provide to the future of emergency nursing?’’ If you truly reflect upon the impact of a scholarship or further education in nursing, it’s an opportunity to create a legacy. We can all be a part of that magnificence. I am a firm believer in action. Help your ENA Foundation create hundreds of legacies. Consider investing in the ENA Foundation and help us broaden the shoulders of emergency nurses throughout our great country. Go to www.enafoundation.org and donate today. Your donation will make a huge difference to your ENA Foundation, your colleagues and your patients. It’s the ultimate investment in emergency nursing, and it begins with you.

March 2014

COURSEBYTES ENPC Provider Manuals ENPC provider manuals shipped on or after Dec. 19, 2013, no longer require an errata sheet. All corrections have been made. The new manuals have ‘‘Updated November 2013’’ printed on the cover and the inside page of the cover.

Holding a Course in Another State Please remember to contact the trauma or pediatric state chair of the state where you plan to teach if you are planning to hold a course in a state other than your home state. This is a requirement of administrative procedures. State chairs are responsible for the quality of courses held in their state and for the scheduling of the monitoring of instructor candidates within their state. This responsibility requires that they are kept well informed of the courses planned within their state.

TNCC 7th Instructor Launch Dates All current TNCC instructors were recently notified via e-mail that in order to carefully consider all of the pilot feedback and results and provide high-quality materials for the courses, the previously published dates for the availability of the course and course products have changed

by a few weeks. They are as follows: • • • •

TNCC 7th edition provider manuals available to ship: Feb. 3 TNCC 7th edition instructor supplement available to ship: Feb. 24 TNCC 7th edition instructor update modules available: Feb. 24 TNCC 7th edition courses can be held by updated instructors, as of: Feb. 24 • All 6th edition TNCC instructors must be updated to 7th edition by: June 30 • No TNCC 6th edition courses can be held after: June 30 Instructions regarding the TNCC 7th edition update materials, which will be available through the ENA website, will be sent closer to the Feb. 24 launch date. Orders for the 7th edition provider manuals can be placed currently by e-mailing courseops@ena.org, accessing the instructor order form on the website, in the TNCC 6th edition instructor team site, through the course director’s

ENA Foundation State Fundraising Challenge Building a Strong Foundation February 1 – May 31

How will your state stack up?

þ þ þ

Largest percentage increase per capita Largest number of individual donations per state Can your state raise more than $5000?

How high can we go? 2014 State Fundraising Challenge visit www.enafoundation.org

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March 2014

access to eCourseOps or by calling Member and Course Services at 800-942-0011. Individual orders for the 7th edition instructor supplements can be submitted once an instructor has passed the online update test. A form will also become available on the same team site by Feb. 24.

Your Input Is Welcome CourseBytes is the official communication to all TNCC and ENPC course directors and instructors. Topic ideas and feedback are welcome at CourseBytes@ena.org.

Risk Meets Reward

Continued from page 7

never received better care, and he presented her with the Spanish flag to show his appreciation. ‘‘To have someone say that to me touched my heart,’’ she said. ‘‘From British to Spanish, you name it, we had the opportunity to take care of a lot of people. It was so rewarding to make a difference, and that’s what we’re there for. ‘‘That’s what I love about military nursing. You can make a difference. If you’re not making a difference in somebody’s life by being a leader and mentoring them, then you’re making a difference in a patient’s life, and that’s huge to me.’’ Going from taking care of patients to becoming one in Afghanistan was a humbling experience for Parris-Atwell. It reminded her that she had a husband and son at home waiting for her. ‘‘It reminds you that your patients are somebody’s son, brother, mother — they’re somebody’s family member,’’ she said. ‘‘They are not just your patient.’’ The ED physician, nurses and tech saved her life, she said, and she will never forget it. ‘‘The reality is I could have not survived,’’ she said. ‘‘It reminded me how vulnerable we are, and we’re all human.’’ She also was reminded of her Air Force nursing motto, “Trusted care anywhere” and the core value of ‘‘Excellence in all we do.’’ If Parris-Atwell had to take this journey all over again, she said she would do it the same way. She loves having the ability to work as a civilian nurse and use her skills in the military as a clinician and leader. ‘‘There are leadership lessons learned on every deployment,’’ she said, ‘‘and from having three, I learned so much about myself as a clinician and as a leader and a mentor. If we can get to soldiers, Marines, etc., and treat their injuries in that golden hour and give them life support care, we can save their lives and have excellent patient care outcomes when they eventually make it home. It still amazes me how far we have come with an exceptional 99.7 percent U.S. service member’s survival rate. I’m so privileged to be involved in that.’’

2014 Call for Nominations

ENA Annual Awards for Nursing Excellence in Emergency Care

o you know someone who has made outstanding contributions to emergency nursing? Past award recipients have been described as role models, mentors and emergency nursing at its finest. Do you know someone who deserves to join this exclusive and prestigious group? This is an opportunity to recognize members’ accomplishments as innovators, leaders and those who continually go above and beyond the call of duty in the emergency nursing profession. Award descriptions, requirements and criteria are posted online. The online nomination form will be available from March 3 to March 31 at www.ena.org/ about/annualawards/Pages/Annual.aspx. The submission deadline is Monday, March 31, at noon CST. AWARD CATEGORIES Clinical/Practice • Clinical Nurse Specialist Award • Frank L. Cole Nurse Practitioner Award • Nurse Manager Award • Nurse Researcher Award • Nursing Competency in Aging Award • Nursing Practice and Professionalism Award Education/Advocacy • Barbara A. Foley Quality, Safety and Injury Prevention Award • Gail P. Lenehan Advocacy Award • Nursing Education Award • Rising Star Award Special Categories • Judith C. Kelleher Award • Lifetime Achievement Award Other • Behind the Scenes Award • Media Award • State Council/Chapter Government Affairs Award • Team Award For questions, please contact AnnualAwards@ena.org.

Official Magazine of the Emergency Nurses Association

EYE EMERGENCIES

A Common Syndrome Presenting With a Dramatic Event By Kathy Szumanski, MSN, RN, NE-BC, Chief Nursing Officer

he staff speculated that the belowzero temperatures and piles of new snow on the roads reduced the typical flow of patient traffic at the beginning of the Saturday night shift. When Margaret arrived at the ED registration area, there were very few patients in the waiting room. Margaret was holding a clean white handkerchief against her left eye and explained that she had a sudden loss of vision while reading at home. She was taken back to the examination area, and when the handkerchief was removed, the nurse noted the eye to be reddened and the lids crusted with dried secretion. Margaret admitted to rubbing her eye to wipe away the drainage. The eye also appeared sunken back in the socket. Margaret’s daughter explained that her mother was active and cared for herself but suffered from rheumatoid arthritis, for which she took the typical over-the-counter pain medication on most days. She added that her mother suffered from chronically dry eyes and mouth for the last several years and had recent bouts of swollen glands along her jaw. When the physician arrived to exam Margaret’s eye, he found a corneal perforation which showed aqueous leakage when a fluorescence strip was applied to the eye surface. When the physician reviewed Margaret’s history, he determined she had Sjögren’s syndrome and notified an ophthalmologist for a consult. The ophthalmologist who came to examine Margaret explained she would need urgent treatment and possible surgery and admitted her to the hospital. He documented in the record a full thickness defect in the cornea, with an opening between the outer chamber of the eye and the eye surface with the presence of Sjögren’s syndrome. Sjögren’s syndrome is a chronic autoimmune disease, and one variant is associated with rheumatologic disorders such as rheumatoid arthritis or systemic lupus erthematosus.1 Its cause is unknown. The symptoms are typically dry eyes and mouth with occasional swelling of the salivary glands. Oral yeast infections can occur, and dental caries due to profound mouth dryness are common. Individuals may experience corneal ulcerations or melting, and on occasion a corneal

perforation occurs due to the severe dryness of the eye. Individuals with Sjögren’s syndrome show abnormal levels of proteins in their blood, which demonstrates that the body is reacting against its own tissue. Because symptoms vary, it can be difficult to diagnose this syndrome, and more than one diagnostic approach may be used. The persistent complaints of dry mouth and eyes may provide a hint, but other tests may be needed to confirm the suspicion of the disorder. There are routine blood tests to look for the presence of immune system proteins such as antinuclear antibody, rheumatoid factor, anti-SSA and SS-B, erythrocyte sedimentation rate and immunoglobulin. Several eye tests are added to the lab evaluation. The Schirmer test that measures tear production may be used, and various dyes may be employed to look for overly dry spots on the eye. A punctual occlusion may be attempted to seal the tear ducts, which drain tears away from the eye. Physicians may do imaging evaluations of the salivary glands or perform a biopsy of the glands. Treatment of Sjögren’s syndrome is generally directed at eliminating the annoying symptoms. Simple remedies such as artificial tears may be useful. More severe problems may be treated by medications such as cyclosporine (Restasis) to reduce inflammation around the eye. Medications that increase saliva flow, such as pilocarpine (Salagan) or cevimuline (Evoxac), may be helpful for mouth symptoms. When more serious symptoms appear, such as generalized rashes, abdominal pain or lung and kidney problems, corticosteroids are prescribed. Sjögren’s syndrome is not life-threatening, but treatment may be needed to support the quality of life. Margaret had an elevated ANA titer and a rheumatoid factor that demonstrated significant disease. While the surgeon anticipated using cyanoacrylate glue to close the defect2, he opted instead for a corneal transplant. Margaret did well and ultimately left the hospital with no further complications. The American College of Rheumatology notes that Sjögren’s syndrome can affect any individual but generally begins between ages 45-55, primarily in women. The ACR

March 2014

estimates that more than 3 million adults may suffer from this disorder and that about one half have other significant rheumatologic diseases. There does appear to be a genetic influence in Sjögren’s syndrome, but the onset of active disease may be due to an environmental trigger that may be viral or bacterial in nature. Active research into this disorder is being conducted by National Institute for Dental and Craniofacial Research teams. In 2009, one of these teams reported that an experimental lab test it designed had correctly identified a key antibody associated with Sjörgren’s syndrome three out of four times accurately.3 References 1. Fox, R.I. (2005). Sjogren’s syndrome. Lancet, 368, 321-331. 2. Jhanil, V., Young, A.L., Mehta, J.S., Sharma, N., Agarwai, T., & Vaipayee, R.B. (2011). Management of corneal perforation. Survey of Ophthalmology, 56, 522-538. 3. Burbelo, P., Ching, K.H., Issa, A.T., Loftus, C.M., Satoh, M., Reeves, W.H., & Iadarola, M.J. (2009). Rapid serological detection of autoantibodies associated with Sjogren’s syndrome. Journal of Translational Medicine, 24, 7-83.

Fellowship Opportunity

National CAUTI Champions Wanted

NA is collaborating with the American Hospital Association and the Health Research and Education Trust to support a national catheter-associated urinary tract infection (CAUTI) fellowship opportunity. The purpose is to provide enriched training, leadership development and expert mentorship to foster the growth of dedicated leaders and CAUTI champions committed to a culture of patient safety. This group of multidisciplinary professionals also will serve to translate these efforts to their organizations and communities through development and completion of a CAUTI-focused capstone project. The 12-month fellowship includes a stipend to participate in fellowship activities, including in-person meetings, networking events, mentorship activities and a Web seminar series on relevant topics. To learn more about eligibility criteria and how to apply by the March 7 deadline, please go to www.onthecuspstophai.org/on-the-cuspstop-cauti/

AGGRESSIVE BEHAVIOR...

...towards staff at work is dramatically on the increase, especially in our Hospitals. Verbal abuse, threats with weapons, cuts, punches, even serious injuries are becoming everyday occurrences. The impact on the confidence and morale of staff is damaging and costly and has a serious impact on the caring and commitment that lies at the heart of the staff/patient relationship. Installing an INSTANTalarm 5000

Staff Personal Alarm System will make a dramatic difference INSTANTalarm does NOT • track you around the hospital • use radio-frequency • rely on unreliable wi-fi • have a computer controlling it

INSTANTalarm, however, DOES

• let you decide when you need help • pinpoint your location, to a room • work instantaneously • make you and your patients feel safer • reduce the frequency and impact of violent incidents Which is why, over 20 years, INSTANTalarm 5000 has been probably the most widely-installed, staff duress alarm system in the world. ®

205.414.7541 www.pinpointinc.com

Official Magazine of the Emergency Nurses Association

® PROTECTING PEOPLE AT WORK

Announcing the EMINENCE Pairs T

he Academy of Emergency Nursing is proud to report that its sixth group of mentors and mentees is currently working on projects for the 2013-2014 program. The EMINENCE program is designed to pair ENA members with experienced Academy fellows. AEN fellow mentors volunteer their time and talents to work with up-and-coming ENA members. This provides a wonderful opportunity to share knowledge and experience with the next generation of emergency nurse leaders. Applicants submit project descriptions and are matched with fellows who have expertise in the subject matter. Project topics include professional presentation, writing for publication, research, educational conference planning and program development. Upon acceptance into the program, mentees pay a $100 administrative fee. The 2013-2014 program mentee/mentor pairs are as follows. MENTEE

MENTOR

Marilee Bennington Arnold, MSN, RN, EMT-P

Laura Criddle, PhD, RN, CEN, FAEN

Kathy Beckett, BSN, RN

Gordon Gillespie, PhD, RN, PHCNS-BC, CEN, CPEN, FAEN

Anne Blevins, MSN, RN, CEN

Cindy Hearrell, MSN, RN, CEN, FAEN

Jessica Castner, PhD, RN, CEN

Gail Lenehan, EdD, MSN, RN, FAAN, FAEN

Royelle Clark, BSN, RN Vicki Patrick, MS, RN, ACNP-BC, CEN, FAEN

AREA OF INTEREST Writing for Publication Research Writing for Publication Research Section Editing Advanced Practice Role Development

Jo-Ann Cummings, PhD, RN, PNP-C, CEN

Lisa Wolf, PhD, RN, CEN, FAEN

Research

Leah Davis, BSN, RN, CEN

Vicki Sweet, MSN, RN, CEN, CCRN, FAEN

Emily DeJonge, MSN, RN, CNL

Maureen O’Reilly Creegan, MSN, RN, CNS,C, CEN, CCRN, FAEN

Marie Hankinson, MSN, RN

Audrey Snyder, PhD, RN, ACNP-BC, FAANP, FAEN

Cathleen Harrington, RN

Kathleen Flarity, DNP, PhD, CEN, CFRN, FAEN

Program Development

John Lunde, MSN, ARNP, CEN, CCRN, CFRN, NREMT-P

Patricia Kunz Howard, PhD, RN, CEN, CPEN, NE-BC, FAAN, FAEN

Writing for Publication

Sonny Ruff, DNP, RN, FNP-C, CEN

Harriet Hawkins, RN, CCRN, CPN, CPEN, FAEN

Professional Presentations

Hemant Sule, BSN, RN, CEN

Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN

Professional Presentations

John Sullivan, BSN, RN, CEN, CPEN

Andrea Novak, PhD, RN-BC, FAEN

Writing for Publication

Nancy Taylor, BSN, RN, CEN

Andrea Novak, PhD, RN-BC, FAEN

Program Development

Elizabeth Tedesco, MSN, RN, CEN, PHRN

Peggy McMahon, MN, APN, NP-C, CEN, FAEN

Writing for Publication

Sean Varricchio, MSN, RN, CEN

Mary Jagim, BSN, RN, CEN, FAEN

Writing for Publication Professional Presentations Research

Emergency Management

If you would like to be part of the EMINENCE program in 2014-15, application information will be posted at www.ena.org in mid-March. Applications are due April 30.

March 2014

Upgrades to Hazmat Incident Resource

he National Library of Medicine has released WebWISER 4.5, the upgrade to the Internet-based version of its Wireless Information System for Emergency Responders. This version includes integrated Chemical Hazards Emergency Medical Management content, as well as the updated 2012 Emergency Response Guidebook. Highlights of the CHEMM integration include new WISER features such as: • New hospital provider and preparedness planner profiles and customized home screens • Acute care guidelines for six of the known mass casualty agents or agent classes • CHEMM reference materials • The CHEMM Intelligent Syndrome Tool, designed to help identify and diagnose the type of chemical exposure seen after a mass casualty incident

WISER is designed to help emergency responders in hazardous material incidents. It provides quick access to information about hazardous substances, including tools and reference materials. Its Substance ID Support can help identify an unknown hazardous material based on signs and symptoms of exposed patients and physical properties gathered by observation, as well as with other key pieces of information. Users also can create profiles based on the role they play in a hazardous materials incident, allowing WISER to provide the information needed for that particular role. WISER is available as a free standalone application for mobile devices, including BlackBerry, Android, Apple iOS and Windows mobile devices. You can access WISER and WebWISER at wiser.nlm.nih.gov.

New ED Toolkit Takes Aim at Atrial Fibrillation More than 2 million Americans suffer from atrial fibrillation, with the number expected to rise to more than 12 million by 2050. A new toolkit, Urgent Matters and the American College of Emergency Physicians, provides step-by-step guidelines for treating a patient who presents to the emergency department with atrial fibrillation, including taking providers through the process of determining a patient’s stroke risk. The free AFIB Toolkit is available for download at smhs. gwu.edu/urgentmatters/ resources/discharge-toolkit.

Your Patient is Proof... You have what it takes. Validate your expertise. Get certified. Visit www.BCENcertifications.org for more information about becoming a: Certified Emergency Nurse (CEN®) Certified Flight Registered Nurse (CFRN®) Certified Pediatric Emergency Nurse (CPEN®) Certified Transport Registered Nurse (CTRN®)

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ENA Corkboard With Leadership Conference 2014 coming to Phoenix on March 5-9, we asked ENA members on Facebook to name their top qualifications for an emergency nursing leader.

Being willing to put on scrubs and work alongs a pair of id crew when things hit th e their Not only does that help e fan! staffing crisis, it boos with the and makes a more cohesits morale Also, it makes you have ve unit. respect for your leader a deep or he is working as ha when she rd and showing how much th as you are action instead of word ey care by s. -Kim Drennen

Recogniti on of the power of education . Not just vocationa collegiate l, or classro o m education but how , it can em power oth prevent in ers, jury, prev e n t disease, promote healing . . . All the t that are e hings mbodied i n nursing come bac all k to recog n i z i n g the pow and impo er rtance of education . Elizabeth Ramirez

The most impactf ul leadership quality is the abili ty to develop and motivate peop le… Leaders that develop and motivate others by believing in th em and the work they do will have a rippling effect no t only in a department but in the people’s lives that are touch ed through them.

Sarah Abel

ader is someone le e rs nu al ion pt ce An ex le nurses, who does not pigeonho ralism and appreciates multicultu ways a learning al is e lif rs be em m re that can lead by e on is so Al . ce en ri expe gy, understands er en d an e pl am ex positive ans and is able to that nurses are hum e rough. see the diamond in th —Joe Kubitschek

The ability to tr eat all staff eq ually. The staf in an ER must f work very clos el y to ge ther and depend hea vily on each ot h er . If yo u don’t treat them equally, you ca u se di vides that can rip a department ap art. Vonne Tucker

ENA CONNECTED Thomas Barbee, Digital Marketing Manager

a must, is r o m u h sense of staff that r A strong u o y f o he trust ling to go il w but also t d n a m ehind the b e r a u o y ry time. e v e m e h t to bat for

n Jen Nelso

s sets the bar high, give ols the staff the right to en to do their job and th er holds each staff memb me accountable to that sa standard across the d board with integrity an fairness. — kevin herm

generation Belief in the younger , there would be because without them Learn to guide no future of nursing. ie Koehlmoos them. -Jennifer Mar

To be able to lead an d make policy from the bedsid e caring for patients with the staff, not from an office or a meeting room. Larry Loewy

Branching Out Through Website, Social Platforms E

ach new year brings exciting opportunities, especially in the world of technology. Last year was particularly busy for ENA with the launch of the new mobile-friendly ENA website. We look forward to continuing to enhance your experience in 2014 in the following ways:

Social Media With more than 25,000 users on our Facebook page and a blooming international presence, we will continue to expand the reach of ENA as a networking opportunity for not only members but anyone with an interest in emergency nursing. We also recently began using Instagram as part of our Emergency Nurses Week™ contest and will continue to use that platform in addition to Twitter, LinkedIn and Google+ as a means to reach out to individuals from all over the world.

Web Experience While the official launch might have occurred last year, we have been making constant tweaks to improve your user experience. Have a suggestion? You can reach us at webmaster@ena.org, as we always encourage feedback. This is just a peek at what you can look forward to in the coming year. We are excited for all that 2014 has in store!

By Josh Gaby, ENA Connection

hirteen-hundred miles north of Cornwall, Ontario, in Iqaluit, the capital of Canada’s vast, sea-divided Nunavut territory, Colleen Andrews, RN, CEN, and her teaching partner split an airport cab with a young man heading to his home last November. After a three-hour flight, the two nurses were making their way to their hotel. But that could wait a few more minutes. ‘‘Would you mind dropping him off first?” Andrews asked the driver. They wanted to see the street where the young man lived: The Road to Nowhere. It was real, and a funny story to tell friends and colleagues back home in Cornwall. For Andrews, though, this remote corner of the world is anything but nowhere. She and her ‘‘tag team’’ partner, Victoria Fortier, MN:AP, CCRN, taught ENA’s Trauma Nursing Core Course to 12 nurses in Iqaluit (pop. 6,600) in

November. In January 2013, they during Andrews’ three days in the brought TNCC to Igloolik (pop. 2,000), island hamlet, where there are no taxis another 600 miles northwest, inside the and most residents get where they’re Arctic Circle. And this February, they going on foot or by snowmobile. were back in Iqaluit to teach ENA’s ‘‘You have to dress appropriately. Emergency Nursing Pediatric Course. There’s no ifs, buts, maybes about ‘‘It’s two courses that I’m very that,’’ Andrews said. ‘‘So I had my passionate in teaching,’’ said Andrews, Sorel winter boots and my down coat, a 30-year emergency nursing veteran mitts, and the only part that was who first took TNCC in the early showing was the eyes.’’ 1990s, became a course Iqaluit has a ‘‘lovely, director in 1996 and has been colorful interior hospital,’’ a faculty member since 2003. Andrews said, but in Igloolik, TNCC — the seventh edition as with many of Nunavut’s of which became available last isolated seaside communities, month — has worldwide reach, there is only a clinic with a having been taught resuscitation room and a contractually in 13 countries mandate as real as the Colleen Andrews, from Kenya to South Korea, temperature outside: The RN, CEN and in one-off classes on five nurses here must handle it continents. But none of those locales is all. Every illness, every injury, every quite like Iqaluit, and closer still to the special need. Pediatric and elderly edge of the earth is Igloolik, a veritable care. Delivering babies. And, of postcard image for outpost nursing. course, any manner of trauma. Start with the obvious: It’s cold. Some of the nurses are locals; others Really cold. Wind chills whipped to are willingly stationed at these clinics to minus-68 in Igloolik (pictured above) fill a need or gain experience. Among

March 2014

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those Andrews taught in Igloolik were two from Newfoundland and Nova Scotia. The nurses have medical directives to follow and can get further instructions from physicians by phone when treating a critically injured patient, but in terms of execution, they’re on their own. ‘‘You have to be very confident in your nursing to work in these areas,’’ Andrews said. ‘‘It takes special nurses to go to outpost nursing — skilled nurses willing to learn. These nurses, they rely on each other, and they’re also a phone call away. However, what happens if they can’t get through? Then it’s their knowledge, their skills that they have been trained [in] before going up or have received while up there by another senior nurse that’s been up there.’’ It’s clear where TNCC and ENPC fit in. Some of Andrews and Fortier’s students had taken TNCC before. Some had merely heard of it but never had

an opportunity to take it. The courses don’t change what the nurses are doing in Igloolik and Iqaluit, but they reinforce the universal essentials. ‘‘I can quickly see nurses who have actually taken the TNCC and ENPC vs. nurses who have not taken the course,’’ Andrews said. ‘‘You walk into a trauma and you have been taught a very easy, systematic approach, and you are focused on airway, breathing, circulation and so forth, down the mnemonic.’’ Skill stations, a staple of the two-day TNCC course, prepare the nurses for ‘‘what-ifs’’ in the context of the area’s lifestyle. ‘‘They might not ever see that type of trauma victim coming into their area,’’ Andrews said, ‘‘but what if a snowmobile person comes in with head trauma? Even if they might have been up there for X number of months, they may not have had a snowmobile injury head trauma. By

giving them this skill-station scenario, it locks it into the back of their brain: ‘OK, this is what I have to do if this person comes in unresponsive, wearing a helmet.’ ’’ Getting course materials so far north

Continued on next page

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www.ena.org/gene § 17 Interactive Modules

§ Up to 15.21 Credit Hours

§ Geriatric Evidence-based Research

The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

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Cold Fusion Continued from previous page requires patience and planning; Andrews starts preregistration eight weeks ahead of a scheduled course because it can take that long for TNCC and ENPC manuals to make it from the United States through Canada Post and onto flights bound for Nunavut. It’s the only hiccup in a continually warm experience for Andrews, never mind the thermometer. She started her career in the deep freeze of Alberta in the winter and later spent three years as a nurse in the Virgin Islands, so she adjusts to any temperature. What attracts her to Iqaluit, Igloolik and outpost nursing is the beauty of new places, the friendly faces, ‘‘the nurses, the doctors that I talk to, and hearing their stories of what brought them up here, too.’’ There’s the locals’ retelling of the day a small polar bear wandered into

The 35-bed Qikiqtani General Hospital in Iqaluit, Nunavut, where Colleen Andrews has taught TNCC and ENPC. The inside is toasty and brightly colored. Igloolik. The ‘‘fashion show’’ of homemade clothing and carvings for guests of the Iqaluit hotel. Gorgeous, endless white against a bright blue sky — landscapes that don’t look like anywhere else. Andrews is delivering the knowledge for better nursing not just somewhere, but somewhere special. ‘‘I knew that nursing opened up a

lot of doors,’’ she said. ‘‘It was one profession that did not just limit you to working in a hospital. You can get into research, teaching, travel. ‘‘I would say to everyone, if you ever get the golden opportunity to travel into these northern areas, bundle yourself up and take your first adventure. Because you have to walk the walk in order to appreciate this.’’

You Can Make A Difference! Come to Washington D.C.

On May 6-7, 2014, please join emergency nursing leaders from across the country for ENA’s Day on the Hill event at the Crystal Gateway Marriott in Crystal City, VA, located just minutes from Washington D.C. and Capitol Hill. Meet with your members of the U.S. Congress and their Capitol Hill Staff. Learn more about advocacy and how you can make a difference in current emergency nursing legislative issues. Contact your ENA State President or Government Affairs Chair for details and reservations or email gov@ena.org with any questions.

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March 2014

BOARD WRITES |

Kathleen E. Carlson, MSN, RN, CEN, FAEN, Secretary/Treasurer

Emergency Nursing Life Lessons A

fter a particularly challenging shift, I shared with a colleague that ‘‘although it was busy, we all played nice in the sandbox.’’ She introduced me to All I Really Need to Know I Learned in Kindergarten, by Robert Fulghum. In this book of essays, Fulghum discusses his kindergarten days and shares the life lessons he learned, which included: • Share everything. • Play fair. • Put things back where you found them. • Clean up you own mess. • Wash your hands before eating. • Live a balanced life. I began to think about some of the lessons I’ve learned during the course of my emergency nursing career. I’d like to share a few.

Caring Begins With Us As caring individuals, we tend to put ourselves last. When I entered nursing school, we were taught to take care of ourselves. ‘‘If you get sick, you’re no good to yourselves or your patients.’’ I’ve learned to listen to my body. Leading a healthy lifestyle, managing stress and finding ways to enjoy life help me adapt to the adverse conditions that come my way. We need to maintain a sense of purpose and have a positive attitude. Finally, if the work environment is too stressful, I’ve learned to exit gracefully.

Safety Trumps All In our hectic environment, it is tempting at times to take shortcuts in order to keep up. Nursing care has become very technical, and it is easy to rely heavily on properly functioning equipment. Safety processes are integral to safe patient care. I am human, and errors

can happen. I need to stay focused and follow protocols to prevent mistakes. Stress, interruptions and poor communication affect safe care. When I scan the patient and the medication before administration or call a ‘‘timeout,’’ I am helping my colleagues and myself be compliant. Above all, I’ve learned to trust my instincts and have a questioning attitude when the situation just doesn’t feel right.

Teamwork Is Valuable When I am part of a fully effective and engaged team, I am able to deliver safe, efficient, quality care in situations that are often stressful and complex. An effective team member works collaboratively, has mutual respect, has positive communication skills and is willing to work with others. This environment enables me to accomplish more than I ever could achieve individually. It also provides a positive learning environment for new members of the team. It is important that we trust each other and that I feel able to

Official Magazine of the Emergency Nurses Association

voice my feelings and concerns when that trust is called into question. Without trust, the environment quickly deteriorates to one of low morale, conflict, dissatisfied staff and patients and, ultimately, increased staff turnover.

Embrace Our New Nurses We all need encouragement and nurturing. New nurses come to the department with a lot of book knowledge but need guidance to develop their skills and manage their time. One of my responsibilities as a professional is to welcome and support them in their journey. Knowledge-sharing is key. I encourage their questions and help them know when to ask for help. After all, these are the nurses who will be caring for me someday. I am very proud to be an emergency nurse, and I have profound respect and thanks for those who guided me along my journey. What lessons have you learned and what will you pass along to those who follow?

C’MON, GET HAPPY

6 Ways to Maintain a Positive Mental Attitude By Kendra Y. Mims, ENA Connection

ome workdays may come with unforeseen obstacles that can throw off your schedule and make the day difficult. Maybe your emergency department is understaffed, so you find yourself working longer hours. Or maybe you’ve spent the majority of your day dealing with a difficult co-worker or an irate patient, or you’ve had to comfort a family who lost a loved one. In spite of the challenges you face, choosing to maintain a positive mental attitude can make a chaotic or stressful day more manageable.

How Do You Talk to Yourself? Do your sentences often begin with “I can’t” or “I’ll never”? Staying positive isn’t just about conversations that happen with others. Being aware of internal dialogue is also key to avoiding negative thinking. According to the Mayo Clinic, self-talk is the endless stream of unspoken thoughts that run through your head every day, whether it’s from logic or misconceptions due to lack of information. Mayo Clinic lists the following as common forms of negative self-talk: • Filtering. When you dwell on and magnify the negative aspects of a situation and filter out the positive factors. • Personalizing. When something bad happens, you assume it is your fault. • Catastrophizing. You expect the worst, which can set the tone for your day. • Polarizing. You often don’t see a happy medium. For example, your work is either a success or a disappointment.

1. AVOID NEGATIVE TALK Perhaps you work with someone who provides unnecessary criticism, belittles others or always points out the problem without offering a solution. Negative energy is draining. Surround yourself with people who will encourage you. If you need to vent your frustrations, seek out someone you trust. ENA’s healthy work environment position statement says that ‘‘health care workers and leadership share the responsibility for respectful, professional and effective communication with zero tolerance for intimidation, abusiveness or bullying.’’ If lateral violence is an issue in your ED, identify ways to create a healthy work environment and become a role model of fostering positive communication.

2. TAKE A MOMENT TO REFLECT Why did you choose to become an emergency nurse? Reflecting on what’s

important can help put a bad day into perspective and renew your passion for your profession. You also can keep a journal nearby to write down the events you encounter on a daily basis and use them as learning opportunities.

3. SURROUND YOURSELF WITH POSITIVE AFFIRMATIONS Keep inspirational quotes in a place where you can see them, such as at your workstation or in your car, or encourage your colleagues to create a positive environment in your nurses’ lounge. Briana Quinn, MPH, BSN, RN, senior associate for wellness and injury prevention for the ENA Institute for Quality, Safety and Injury Prevention, suggests creating a positive-only break room: Anyone complaining is made aware of what he or she is doing; those who persist have to dine elsewhere. To

help foster a positive environment, Quinn says, emergency nurses also can post positive comments from patients to staff or from peer to peer on a recognition board and use the board to recognize and award staff who have been praised by patients or their peers.

4. CREATE A LIST OF GOALS Knowing what you want to accomplish and creating a plan to pursue your goals — career, vacation, volunteering/hobbies and family/friends — can keep you motivated even in challenging moments. ‘‘Chart out what you will need to do financially and educationally and include a timeline to achieve these goals,’’ Quinn said. ‘‘Strive for a balance between each of these categories in your life. Think of a stool. Each of these categories is one leg of the stool, and you need to have all four in place to

March 2014

hold yourself up.’’ Having hobbies and goals can be beneficial during stressful days. ‘‘If you are having a rough patch with family life and difficulties at work, you can escape productively and positively with a hobby or talent you are nurturing,’’ Quinn said. ‘‘Having goals and actively working toward them will help you move forward in a purposeful direction instead of feeling helpless.’’

5. GET PLUGGED IN SPIRITUALLY Spiritual health is often linked to emotional, mental and physical health. Whether it’s prayer, attending a place of worship, meditation or nature, the definition of spiritual wellness is different for everyone, as it is often connected to discovering a sense of one’s purpose in life. Quinn said spiritual wellness also includes volunteering and connecting to others. ‘‘Take time each day to reflect on

what is important to you and what holds meaning in your life,’’ she said. ‘‘Could you be a better person in ‘x’ category? Is there a relative you haven’t corresponded with in a meaningful manner in some time beyond social media? Do you feel that you could give back more to your community, or have you seen a neighbor who could use a helping hand?’’

6. LAUGH Laughter is a natural mood booster. As an emergency nurse, you can experience a traumatic situation on any given day. Sometimes a good laugh is the refreshing break we all need, Quinn said. She encourages emergency nurses to develop self-awareness and identify ways they can improve themselves without feeling guilt. ‘‘Remember that the emergency department is an ever-changing place,’’ she said, ‘‘and one rough shift is just that . . . one rough shift.’’

If you’re attending Leadership Conference 2014 in Phoenix, be sure to join your colleagues Friday, March 7, from 6:30 to 7:30 a.m. for ENA’s first offered course on meditation. Learn to de-stress at work in less than one minute, as well as longer meditation techniques. No special clothing is required. Come dressed ready to head straight to the Opening Session! References Gokenbach, V. (2012). Nursing wellness: Toolkit to a happy work life. Retrieved from www.nursetogether. com/nursing-wellness-toolkit-to-ahappy-work-lifePositive thinking: Reduce stress by eliminating negative self-talk. (2011). Retrieved from www.mayoclinic.org/ positive-thinking/ART-20043950

Invest In Your Education ENA Foundation Will Too

Apply for an academic scholarship today! • Scholarships range from $2,500 - $10,000 • Since 1991 we have presented a total of $1.5 million • In 2014 the ENA Foundation will award $158,000

Advance the future of emergency nursing, advance your education, with the ENA Foundation

Submission deadline is June 1, 2014. Please visit www.enafoundation.org for a complete list of scholarships, requirements, and applications. ENA Foundation Scholarship Ad_Connection_half_03 2014.indd 1

Official Magazine of the Emergency Nurses Association

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Q: Recently, patients have been using smartphone apps to identify wait times before coming to be seen in emergency departments. When the patient comes in expecting to be seen in 15 minutes because ‘‘the app says so,’’ it puts registered nurses and other health care workers in the ED in an awkward position. We are challenged to provide answers to the patient regarding a longer wait time than anticipated. Any suggestions? A: With patient access to technological advances, patient care delivery challenges arise. Since most EDs are not providing this information to patients, it becomes difficult for the patient to understand. The patient needing an ED visit looks at the information on the app, sees a hospital close by has a 15-minute wait time and speeds off to the hospital, not realizing that in the five minutes it takes him to get there, two traumas and five other patients have come in before he arrives. Of course, the patient is confused about the delay and unhappy he has to wait

2014 ANNUAL CONFERENCE

Use ‘‘Ask ENA’’ to ask about the organization and emergency nursing in general. Questions will be referred to the appropriate ENA staff or department. Submission does not guarantee publication. E-mail questions to connection@ena.org. longer than anticipated. Every organization would like its patients to be happy and well taken care of. ENA supports the American College of Emergency Physicians policy statement that the reporting of emergency department patient waiting times for initial evaluation should be standardized — for example, that the ED patient wait time should be defined as door-to-provider contact time. The full policy statement provides additional useful information. It can be found at tinyurl.com/EDWaiting. — Paula M. Karnick, PhD, ANP-BC, CPNP, Director of the Institute for Emergency Nursing Education

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March 2014

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From the President Continued from Page 3 clear communication, there should be no unnecessary conversation in the room. The team leader should be clearly identified, and orders should be given by the team leader and directed to a particular member of the team. That team member should repeat back the order to ensure it was received correctly. For example, the team is treating a patient in septic shock. The team leader says, ‘‘Judy, please give the patient 1 liter of normal saline on the rapid infuser.’’ Judy should respond, ‘‘I will give the patient 1 liter of normal saline on the rapid infuser.” All too often, an order is called out to no one in particular, and it’s assumed someone heard and will carry it out. Other times, the order is directed at a specific team member; however, that team member might be distracted with another task and miss the message or not hear the message correctly. Using this check-back ensures the message was received by the correct person at the correct time and was heard correctly. This simple step can help reduce the likelihood we will make an error. Who is going to make sure this gets done in my department? While sentinel events in the ED often are caused by catastrophic failures in communication between multiple team members, the good news is that it just takes one person to stop the line and speak up. We cannot wait for system overhauls and staff buy-in to change. We each need to commit to changing the way we communicate in the ED now. Make a conscious choice to stop referring to patients by their room number. Champion the use of check-backs in critical situations. It takes courage to be a role model and commit to changing your own practice. Sitting back and waiting until someone tells you that you must change ensures that the mistake will happen. I don’t know about you, but I don’t want to be the patient in the bed when it does.

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Official Magazine of the Emergency Nurses Association

28 41 55 68 %

Average improvement in throughput for admitted and discharged patients

Average improvement in time from arrival to seeing a physician.

Typical improvement in patient satisfaction scores and likelihood to recommend

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Average improvement in LWBS rates, resulting in an additional $1.6 million in collected revenue

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